Happy Haven Academy Enrollment Form

Happy Haven Academy

Enrollment Form
Child's Name

First NameLast Name
Gender

BoyGirl
Date of birth

MonthDayYear
Date
Mother's Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Who has parental responsibility?

MotherFatherOther
Please specify
Person authorized to pick up child

First NameMiddle NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Person to call in case of emergency

First NameLast Name
Name

First NameMiddle NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Should be Empty: